Psychology

Question 1

Define attitude.

Answer 1

• Attitude: a positive or negative evaluative reaction toward a stimulus, such as a person, action, object, or concept e.g. can include behaviour such as healthy eating
• Attitudes influence behaviour more strongly when situational factors that contradict our attitudes are weak

Question 2

Describe the theory of planned behaviour.

Answer 2

Diagram

Question 3

Describe cognitive dissonance.

Answer 3

Conflict between 2 opposing beliefs

Resolving dissonance
• Change behaviour: In the case of smoking, this would
involve quitting, which might be difficult and thus avoided
• Acquire new information: Such as seeking exceptions
e.g. “My grandfather smoked all his life and lived to be 96”
• Reduce the importance of the cognitions (i.e. beliefs,
attitudes). A person could convince themself that it is better to “live for the moment”

Changing attitudes

Message more effective if:
• Reaches recipient 
• Is attention-grabbing 
• Easily understood 
• Relevant and important 
• Easily remembered

Question 4

Describe framing.

Answer 4

Refers to whether a message emphasises the benefits or losses of that behaviour

Loss frame: if you do undertake breast self-examination you may decrease the risk of dying from cancer
Gain frame: if you do use SPF 15 sunscreen, your skin will stay healthier and you may prolong your life

Question 5

Describe stereotypes and prejudice.

Answer 5

• Stereotype – Generalisations made about a group of people or members of that group, such as race, ethnicity,
or gender. Or more specific such as different medical specialisations (e.g. surgeons)
• Prejudice – To judge, often negatively, without having relevant facts, usually about a group or its individual members
• Discrimination – Behaviours that follow from negative evaluations or attitudes towards members of particular groups

Question 6

Describe social loafing.

Answer 6

Definition - the tendency for people to expend less individual effort when working in a group than when working alone

More likely to occur when:
• The person believes that individual performance is not being monitored
• The task (goal) or the group has less value or meaning to the person
• The person generally displays low motivation to strive for success
• The person expects that other group members will display high effort
Depends on gender and culture
• Occurs more strongly in all-male groups
• Occurs more often in individualistic cultures
Social loafing may disappear when:
• Individual performance is monitored
• Members highly value their group or the task goal
• Groups are smaller
• Members are of similar competence

Question 7

Describe conformity.

Answer 7

Factors that affect conformity:
• Group size:
-Conformity increases as group size increases
-No increases over five group members

• Presence of a dissenter:
•-One person disagreeing with the others greatly reduces group
conformity

• Culture:
-Greater in collectivistic cultures

Question 8

Describe bystander apathy.

Answer 8

5-Step Bystander Decision Process

1) Notice the event
2) Decide if the event is really an emergency
Social comparison: look to see how others are responding
3) Assuming responsibility to intervene
Diffusion of Responsibility: believing that someone else will help
4) Self-efficacy in dealing with the situation 5) Decision to help (based on cost-benefit analysis e.g. danger)

Increasing help behaviour
Reducing restraints on helping
• Reduce ambiguity and increase responsibility
• Enhance concern for self image

Socialise altruism 
• Teaching moral inclusion 
• Modelling helping behaviour 
• Attributing helpful behaviour to altruistic motives 
• Education about barriers to helping

Question 9

Describe obedience.

Answer 9

Factors That Influence Obedience:
• Remoteness of the victim
• Closeness and legitimacy of the authority figure
• Diffusion of responsibility: obedience increases when someone
else administers the shocks • Not personal characteristics

Question 10

Describe group decision making.

Describe leadership and team working.

Answer 10

Groupthink - the tendency of group
members to suspend critical thinking because they they are striving to seek agreement

Group polarization - the tendency of people to make decisions that are more extreme when they are in a group as opposed to a decision made alone or independently

Groupthink
Most likely to occur when a group: 
• Is under high stress to reach a decision 
• Is insulated from outside input 
• Has a directive leader 
• Has high cohesiveness

Leadership and team working
• Newly qualified doctors must recognise the role of doctors in contributing to the management and leadership of the
health service.
• Describe the principles of how to build teams and maintain effective team work and interpersonal relationships with a clear
shared purpose
• Undertake various team roles including, where appropriate, demonstrating leadership and the ability to accept and support
leadership by others
• Identify the impact of their behaviour on others
• Describe theoretical models of leadership and management that may be applied to practice.

Leadership styles

Autocratic or authoritarian style
• Under the autocratic leadership style, all
decision-making powers are centralized in the leader, as with dictator leaders.
• They do not entertain any suggestions or
initiatives from subordinates.
Participative or democratic style
• The democratic leadership style favours
decision-making by the group as shown, such as leader gives instruction after consulting the group. They can win the co-operation of their group and can motivate them effectively and positively.
Laissez-faire or “free rein” style
• A free-rein leader does not lead, but leaves the group entirely to itself as shown; such a leader allows maximum freedom to subordinates, i.e., they are given a free hand in deciding their own policies and methods.

Advantages and disadvantages
Table

Question 11

Define a medical error.

Answer 11

An error is defined as the failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning).
E.g. incorrect diagnosis
failure to employ indicated tests error in the performance of an operation, procedure, or test, error in the dose or method of using a drug.

Nurse-doctor relationships, nurses agree to doctor even if mistake

Causes of medical errors (highest to lowest)

• both system-related and cognitive factors
• cognitive error only
• system-related error only
• no-fault factors only

Diagnostic errors
diagnostic errors — not surgical
mistakes or medication overdoses — accounted for:
- the largest fraction of claims,
- the most severe patient harm (Diagnostic errors more often resulted in death)
- the highest total of penalty payouts

Question 12

Describe clinical decision making.

Answer 12

Clinicians rarely use formal computations to make patient care decisions in day-to-day practice.
• Intuitive understanding of probabilities is combined with cognitive processes called heuristics to guide clinical judgment.
• Heuristics are often referred to as rules of thumb, educated guesses, or mental shortcuts.
• Heuristics usually involve pattern recognition and
rely on a subconscious integration of patient data with prior experience

There are two systems for decision making
Hot system (system 1) - shout look out!
Cold system (system 2) - override system 1 in illusions
(Look at table)

System 1 often controls our actions automatically but system 2 is blissfully unaware, believing itself to be in charge

Question 13

Describe confirmatory bias and overconfidence in medicine.

Answer 13

• The tendency to search for or seek, interpret, for alternatives and recall information in a way that confirms one’s preexisting beliefs or hypotheses, often leading to errors
• Is confirmation bias to blame for the
ineffective medical procedures that were used for centuries before the arrival of scientific medicine?
• When evaluating a diagnosis be sure to test

BREXIT vote - if one option, seek info to confirm opinion

Overconfidence in Medicine
• Podbregar and colleagues studied 126
patients who died in the ICU and underwent
autopsy
• Physicians were asked to provide the
clinical diagnosis and also their level of
uncertainty
• Clinicians who were “completely certain” of
the diagnosis ante-mortem were wrong 40%
of the time

Question 14

Describe the Sunk Cost Fallacy.

Answer 14

• Sunk costs are any costs that have been spent on a project that are
irretrievable ranging including anything from money spent building a house to expensive drugs used to treat a patient with a rare disease.
• Rationally the only factor affecting future action should be the future costs/benefit ratio but humans do not always act rationally and often the more we have invested in the past the more we are prepared to invest in a
problem in the future, this is known as the Sunk Cost Fallacy.
• Bornstein et al (1999) found that medical residents’ evaluation of treatment decisions were not influenced by the amount of time and/or money that had already been invested in treating a patient.
• However, the residents did demonstrate a sunk-cost effect in evaluating non-medical situations.

E.g. waiting for lift for long and wont use stairs because already waiting a while

Question 15

Describe anchoring.

Answer 15

• Individuals poor at adjusting estimates from a given starting point (probs. & values)
• Adjustments crude & imprecise
• Anchored by starting point
• A working diagnosis of acute pancreatitis may seem quite reasonable in a 60-yr-old man who has epigastric pain and nausea, who is sitting forward clutching his abdomen
• However, the patient states that he has had no alcohol in many years and investigations show normal blood levels of pancreatic enzymes
• Clinicians may simply dismiss or excuse conflicting data (eg, the patient is lying, his pancreas is burned out, the laboratory made a mistake)

Question 16

Describe probability in medial situations and representativeness heuristic.

Answer 16

Many clinical situations involve making decisions on the basis of probabilities e.g. two or more competing diagnoses, alternative treatments which may be effective etc.

Representativeness heuristic
• Subjective probability that a stimulus belongs to a particular class based on how ‘typical’ of that class it appears to be (regardless of base rate probability)
• While often very useful in everyday life, it can also result in neglect of relevant base rates and other errors
E.g. neighbour has book always; he is either librarian/ police but you think Liberian; also probability wise police > librarian in UK

Representativeness errors
• A 60-yr-old woman who has no known medical problems and who now looks and feels well reports experiencing symptoms earlier of feeling short of breath, sweaty and clammy, feeling sick, and feeling
faint.
• This does not match the typical profile of an MI, which is typically characterised by chest pain.
• BUT, it would be unwise to dismiss that possibility because MI is common among women of that age and has highly variable presentations.

Assessing conditional probabilities

• A woman presents to you with a lump in her breast. From your examination, her age and your previous records of similar cases, you estimate that the chance of cancer is low, about 1% (p=.01).
• You send her to the radiologist for a mammogram and the radiologist says the mammogram is positive, indicating cancer.

Question 17

Describe framing and age.

Answer 17

When presented with treatment descriptions described in positive, negative, or neutral terms, older adults are significantly more likely to agree to a treatment when it is positively described than they are to agree to the same treatment when it is described neutrally or negatively

Question 18

Describe the availability heuristic and availability errors.

Answer 18

The availability heuristic
• Probabilities are estimated on the basis of how easily and/or vividly they can be called to mind.
• Individuals typically overestimate the frequency of occurrence of catastrophic, dramatic events
e.g. surveys show 80% believe that accidents
cause more deaths than strokes
• People tend to heavily weigh their judgments toward more recent information

Availability errors
For example, a clinician who recently missed
the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort but no other findings or apparent risk factors might then overestimate the risk in similar patients and become more likely to do chest CT angiography for similar patients despite the very small probability of disease.

Question 19

How can decision making be improved?

Answer 19

1) Education and Training
Integrate teaching about cognitive error and diagnostic error into medical school curricula Recognise that heuristics and biases may be affecting our judgement even though we may not be conscious of them
2) Feedback
Increase number of autopsies Conduct regular and systematic audits Follow-up patients
3) Accountability
Establish clear accountability and follow-up for decisions made
4) Generating alternatives
Establish forced consideration of alternative possibilities e.g., the generation and working through of a differential diagnosis. Encourage routinely asking the question: What else might this be?
5) Consultation
Seek second opinions Use of algorithms Use of clinical decision making support systems

Question 20

Describe algorithms.

Answer 20

• An algorithm is a procedure which, if followed exactly, will provide the most likely answer based on the evidence.
• The rules of probability are examples of algorithms.
• Algorithms are most useful in situations where the problem is well defined - which excludes many everyday decisions
• For the most part, people have to be taught how to use them

Question 21

Define learning and describe the basic learning process.

Describe habituation and sensitisation.

Answer 21

“a process by which experience produces a relatively enduring change in an organism’s behavior or
capabilities.”

Basic learning process:
– Non-associative learning – response to repeated stimuli
– Classical conditioning – Learning what events signal (associative - signal/stimulus with something else)
– Operant conditioning - Learning one thing leads to another
– Observational learning – Learning from others

• Habituation is a decrease in the strength of a
response to a repeated stimulus.
• Sensitisation is an increase in the strength of
response to a repeated stimulus.
• Responses happen simultaneously and
compete to determine behaviour

Question 22

Describe classical conditioning.

Answer 22

Dog salivates in response to food and bell rings

Stimuli
-Unconditional stimulus (UCS): A stimulus that elicits a reflexive or innate response (the UCR) without prior learning (food)

-conditioned stimulus (CS): A stimulus that through association with a UCS, comes to elicit a conditioned response similar to the original UCR (bell)

Responses
-Unconditioned response (UCR): A reflexive or innate response that is elicited by a stimulus (the UCS) without prior learning (salivation)

-Conditioned response (CR): A response elicited by a conditioned stimulus (salivation)

Classical conditioning is strongest when:
– There are repeated CS-UCS pairings
– The UCS is more intense (fear e.g. involved in fire, smoke smelt so when burnt toast at home scared - UCR)
– The sequence involves forward pairing (i.e. CS -> UCS) (CS before UCS)
– The time interval between the CS and UCS is short

Question 23

Describe extinction.

Describe stimulus generalisation and discrimination.

Answer 23

1) Acquisition (CS-UCS pairings) - few trials to learn
2) Extinction (CS alone) - slowly drops when trials stopped
3) First spontaneous recovery (CS alone)
4) Second spontaneous recovery (CS alone)

Just turning down response; response still persists

Stimulus generalisation
A tendency to respond to stimuli that are
similar, but not identical , to a conditioned
stimulus e.g. similar sounds; brands mimic well-known brands so we associate

Similar stimuli will also elicit the CR, but in a
weaker form
Eg, a 500Hz tone elicits the CR, tones of similar frequency will also elicit CR, the closer the tone to the original the stronger the response

Stimulus discrimination
• The ability to respond differently to various
stimuli.
– E.g. A child will respond differently to various bells (alarms, school, timer) – A fear of dogs might only include certain breeds

• A significant proportion (25-30%) of patients undergoing chemotherapy experience anticipatory
nausea and vomiting.
• Chemotherapy (UCS) —> Nausea (UCR)
• Related cues e.g. Sight of chemotherapy Unit (CS) —> Anticipatory Nausea (CR)

Question 24

Describe conditioning and immune system function.

Describe overshadowing.

Describe classical conditioning and fear learning.

Answer 24

• Took blood samples of patients at home and at hospital prior to chemotherapy
• Patients rated their feelings of nausea and
their NK Cell activity was measured in
response to mitogens

• Cancer patients divided into two groups
• Group one given unpleasant, novel drink
• Group two given water
• Patients in group one showed significantly
reduced nausea to clinic setting alone i.e. the
CS had been altered

Classical conditioning and fear learning
Little Albert experiment - rat and loud noise

Fear learning - needle phobia
Traumatic injection —> pain/fear
Trauma (UCS) and needle (CS) —> fear response (UCR)
Clinic setting (CS) —> fear response (CR)

Two-factor theory of maintenance of classically conditioned associations e.g. fear
Trauma (UCS) and needle (CS) —> fear response (UCR)
Avoid injections —> fear reduced —> tendency to avoid is reinforced

Thornidike’s Law of Effect
A response followed by a satisfying consequence will be more likely to
occur.
A response followed by an aversive
consequence will become less likely
to occur

Operant conditioning
Behaviour is learned and maintained by it’s consequences

Question 25

Describe reinforcement and punishment.

Answer 25

Reinforcement
Positive Reinforcement: occurs when a response is strengthened by the subsequent presentation of a reinforcer
– Primary Reinforcers: those needed for survival e.g. food, water, sleep, sex
– Secondary Reinforcers: stimuli that acquire reinforcing properties through their association with primary reinforcers e.g. money, praise

Negative Reinforcement: occurs when a
response is strengthened by the removal (or
avoidance) of an aversive stimulus
– Negative Reinforcer: the aversive stimulus that is removed or avoided (e.g. the use of painkillers are reinforced by removing pain)

“Positive” and “Negative” refer to
presentation or removal of a stimulus, not
“good” and “bad”

Punishment
Positive Punishment: occurs when a response is weakened by the presentation of a stimulus (e.g. squirting a cat with water when it jumps on dining table)
Negative Punishment: occurs when a response is weakened by the removal of a stimulus (e.g. phone confiscated)

Reinforcement (increasing behaviour) vs punishment (decreasing behaviour)

• Skinner maintained that reinforcement is a much more potent influence on behaviour than punishment
• Largely because punishment can only make
certain responses less frequent – you cant teach new behaviour (just turn down existing behaviour)
• Implications for teaching and behaviour change?

Reinforcement schedules
• Continuous reinforcement produces more rapid learning than partial reinforcement
– The association between a behaviour and its consequences is easier to understand
• However, continuously reinforced responses
extinguish more rapidly than partially reinforced responses
– The shift to no reinforcement is sudden and easier to understand

Fixed interval schedule: reinforcement occurs after fixed time interval

Variable interval schedule: the time interval varies at random around an average

Fixed Ratio Schedule: reinforcement is given after a fixed number of responses

Variable Ratio Schedule: reinforcement is given after a variable number of responses, all centered around an average

Reinforcement and behaviour
Variable reinforcement better - sometimes you win, sometimes you lose - gambling

Question 26

Describe operant conditioning and health behaviour.

Answer 26

• Chronic pain behaviour includes
limping, grimacing, and medication requests.
• This is often reinforced by family
or staff e.g. by being overly sympathetic, encouraging rest, increasing medication
• This behaviour is likewise reinforced by gratitude signals from the patient
• A cycle is created in which the patient receives positive consequences for “being in pain“, so pain is more likely to occur in
frequency

Question 27

Describe the cognitive approach and social learning theory.

Answer 27

• Unlike Skinner, Bandura believes that humans are active information processors and think about the relationship
between their behaviour and its consequences.
• Social imitation may hasten or short-cut the
acquisition of new behaviours without the
necessity of reinforcing

Social learning theory 
-Observational (vicarious) learning - We
observe the behaviours of others and  the
consequences of those behaviours.
-Vicarious reinforcement - If their
behaviours are reinforced we tend to
imitate the behaviours

Modelling or Observational learning
• Occurs by watching and imitating actions of another person, or by noting consequences of a person’s actions
– Occurs before direct practice is allowed
• Steps to Successful Modeling
– Pay attention to model
– Remember what was done
– Must be able to reproduce modeled behavior
– If successful or behavior is rewarded, behavior more likely to recur

Bobo Doll Experiment
Adult watched either non-aggressive or aggressive behaviour
Behaviour observed and imitated by children

Social Learning 
• We don’t imitate the behaviour of everyone
we encounter 
• More likely if model is:
– Seen to be rewarded 
– High status (e.g. Medical consultant) 
– Similar to us (e.g. colleagues) 
– Friendly (e.g. peers)

Question 28

What are the biggest factors that lead to death?

Define health behaviour.

Answer 28

• dietary excess
• alcohol consumption
• lack of exercise
• smoking
• unsafe sexual behaviour

Any activity undertaken by an individual believing himself to be healthy, for the purpose of preventing disease or detecting it at an asymptomatic stage

Question 29

Describe behaviour change interventions.

Answer 29

Population - social media campaigns, health promotion

Individual - motivative interviewing, reconsider smoking and alcohol intake

Community - cardiac rehabilitation

Smoking education in schools

The role of education
• Information does have an important role and is most effective for discrete behaviours (eg getting a child vaccinated)
• Messages tailored to a particular audience are more effective (eg complete abstinence Vs condom use to reduce teenage pregnancy)
• But often people need more than knowledge to change habitual lifestyle behaviours, particularly addictive behaviours (eg social & psychological support, skills to change)

Question 30

Describe theories and models of behaviour change.

Answer 30

Learning theory - cues for unhealthy eating (emotion driven eating)
Visual (eg. fast food signs, sweets at checkout)
Auditory (eg. ice cream bell)
Olfactory (eg. smell of baking bread)
Location (eg. the couch or car)
Time (eg. evening)/ Events (eg. end of TV programme )
Emotional (eg. bored, stressed, sad, happy).

Reinforcement Contingencies
Positive reinforcement:
-Dopamine (feel good), filling an empty void/boredom.
-Praise for preparing a high-fat meal for the family.
Negative Reinforcement:
-Avoid painful emotions by comfort eating. Punishment:
-Preparing a low fat meal is criticised.
Limited/delayed positive reinforcement for healthy eating:
-Efforts at dietary change/weight loss go unnoticed by others; Avoiding future health problems is too remote.

Behaviour modification techniques

Examples of contingency management: -Involve significant others to praise healthy eating choices
-Plan specific rewards for successful weight loss
-Vouchers for adherence to healthy eating & weight loss.
Naturally occurring reinforcers:
-Improved self-esteem (positive reinforcement).
-Reduction in symptoms of breathlessness (negative reinforcement).

Limitations of reinforcement programmes
• Lack of generalization (only affects behaviour regarding the specific trait that is being rewarded).
• Poor maintenance (rapid extinction of the desired behaviour once the reinforcer disappears)
• Impractical and expensive.

Fear arousal
Scaring people not best tactic - doesn’t really work

Social learning

• Adolescents are particularly susceptible to social influences given their developmental stage and the importance of school and peer groups.
• Substantial peer group homogeneity with respect to adolescent smoking.
• Best friends have the greatest influence on adolescent smoking, followed by peer groups.

Question 31

Describe social-cognition models of behaviour change.

Answer 31

Expectancy-value principle
The potential for a behaviour to occur
in any specific situation is a function
of  the expectancy that the behaviour
will lead to a particular outcome and
the value of  that outcome
E.g. cardiac rehab, those with MI - may change eating habits because received lots of information from cardiologist, if they want to live longer, they’ll do this 

Health beliefs model
Diagram
E.g. decision to get a flu vaccine
• Susceptibility – “A lot of people I know have
got flu symptoms”
• Seriousness – “It’s not something to really
worry about”
• Benefits – “The vaccination will stop me
getting sick”
• Costs/barriers - “The injection will be painful and it might make me ill for a while”
• Cues – Doctor strongly advises to have it.

Smoking cessation using the HBM

• Explore Cues to Action:
Has anything made you think about giving up smoking?
• Explore perceived susceptibility and severity: How do you think smoking is affecting your health? What would it be like if you got it (eg lung cancer)?
• Explore perceived benefits and barriers: What are the pros and cons of smoking for you? Is there anything stopping you from quitting?

Efficacy beliefs
• Outcome efficacy - Individuals
expectation that the behaviour will lead
to a particular outcome
• Self  Efficacy - Belief that one can
execute the behaviour required to
produce the outcome

Factors influencing self efficacy

1. Mastery experience - driving lessons and driving instructor
2. Social learning - observing someone
3. Verbal persuasion or encouragement - feedback
4. Physiological arousal - fight or flight (if we accept this is normal response to trying out something new - its fine)

The theory of planned behaviour
Diagram

Smoking cessation using the TPB
-Explore attitudes towards smoking: What do you think about smoking? Is smoking a good or bad thing for you?
-Explore the norms of important people around her: What do your friends/family think about you smoking? Would
you like to quit for [person]?
-Explore whether she intends to quit smoking: Have you ever thought about quitting? Do you intend to quit in the next few months?
-Explore how much control she thinks she has: Do you think you can quit? What makes you think that you
can’t?

Theoretical (Stages of change) model
Diagram
COM-B: The behaviour change wheel
Diagram